EP1500393A1 - Injectable composition containing taxol - Google Patents

Injectable composition containing taxol Download PDF

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Publication number
EP1500393A1
EP1500393A1 EP04020044A EP04020044A EP1500393A1 EP 1500393 A1 EP1500393 A1 EP 1500393A1 EP 04020044 A EP04020044 A EP 04020044A EP 04020044 A EP04020044 A EP 04020044A EP 1500393 A1 EP1500393 A1 EP 1500393A1
Authority
EP
European Patent Office
Prior art keywords
acid
paclitaxel
acidifying agent
taxol
castor oil
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP04020044A
Other languages
German (de)
French (fr)
Inventor
Timothy R. Prout
Hernita Ewald
Paul Handreck
Robyn Elliott
David R. Carver
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Mayne Pharma USA Inc
Original Assignee
Mayne Pharma USA Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
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Application filed by Mayne Pharma USA Inc filed Critical Mayne Pharma USA Inc
Publication of EP1500393A1 publication Critical patent/EP1500393A1/en
Withdrawn legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/0012Galenical forms characterised by the site of application
    • A61K9/0019Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/335Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/335Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
    • A61K31/337Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having four-membered rings, e.g. taxol
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/10Alcohols; Phenols; Salts thereof, e.g. glycerol; Polyethylene glycols [PEG]; Poloxamers; PEG/POE alkyl ethers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/12Carboxylic acids; Salts or anhydrides thereof
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/06Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
    • A61K47/08Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
    • A61K47/14Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/44Oils, fats or waxes according to two or more groups of A61K47/02-A61K47/42; Natural or modified natural oils, fats or waxes, e.g. castor oil, polyethoxylated castor oil, montan wax, lignite, shellac, rosin, beeswax or lanolin

Definitions

  • This invention relates to a solution of taxol (paclitaxel) having improved stability.
  • Taxol is a compound extracted from the bark of a western yew, Taxus brevifolia and known for its antineoplastic activity. It is described for example in The Merck Index, Eleventh Edition 1989, monograph 9049.
  • taxol was chosen for development as an antineoplastic agent because of its unique mechanism of action and good cytotoxic activity against IP implanted D16 melanoma and the human X-1 mammary tumor xenograft.
  • Taxol is believed to function as a mitotic spindle poison and as a potent inhibitor of cell replication in vitro. Other mitotic spindle points (colchicine and podophyllotoxin) inhibit microtubule assembly. Taxol employs a different mechanism of action since it appears to shift the equilibrium of polymerimization/depolymerization toward polymer assembly and to stabilize microtubules against depolymerization under conditions which would cause rapid disaggregation of microtubules. The interference with the polymerization/depolymerization cycle in cells appears to interfere with both the replication and migration of cells.
  • taxol After extensive preclinical screening in mouse tumour models, taxol entered clinical trials in 1983. Over the past few years, taxol has demonstrated good response rates in treating both ovarian and breast cancer patients who were not benefiting from vinca alkaloid or cisplatin therapy. It has also shown encouraging results in patients with other types of cancer including lung, melanoma, lymphoma, head and neck.
  • the invention provides a solution containing taxol, cremophor ELTM and ethanol, characterized in that the pH of the solution has been adjusted into the range 1 to 8 by addition of an acid.
  • Acids in the form of powders for example citric acid, are preferred over those which contain water, for example sulfuric acid.
  • the most preferred acid for use in accordance with the present invention is citric acid but a wide range of acids may be used including the following:
  • Taxol Due to its limited solubility in water, Taxol is usually prepared and administered in a vehicle containing cremophor ELTM (a polyethoxylated castor oil which acts as a solubilizer) and ethanol.
  • cremophor ELTM a polyethoxylated castor oil which acts as a solubilizer
  • ethanol a commercially available solution supplied by Bristol-Myers Squibb (BMS) is formulated with these components and has a pH of 9.1.
  • the invention essentially teaches addition of an acid to a taxol formulation to adjust its pH into the range 1 to 8, preferable 5 to 7.
  • Citric acid was dissolved in absolute alcohol, using a ratio of 8mls of absolute alcohol to 1 gram of citric acid, and the solution was stirred for fifteen (15) minutes.
  • Cremophor EL was weighed out into the main mixing vessel.
  • Solution 1 was added to solution 2, and the container used for solution 2 was washed with a minimum quantity of absolute alcohol to ensure complete transfer of the citric acid.
  • Solution 3 was mixed and bubbled with nitrogen for at least 15 minutes.
  • the taxol was weighed out and slurried using absolute alcohol, using a ratio of 8ml of absolute alcohol to 1 gm of taxol.
  • the slurried taxol was added to solution 3 and the slurrying vessel was washed with a minimum quantity of absolute alcohol.
  • Solution 3 was adjusted to 75% of required volume using absolute alcohol, and thoroughly stirred for at least 45 minutes until completely dissolved. Once completely dissolved, the volume, was checked and made up as necessary with absolute alcohol and the final solution stirred for 5 minutes.
  • a solution was prepared with the following formulation: Formulation: (Sample 1) Cremophor EL 0.5mL Citric Acid (Anhydrous) 2.0mg Taxol 6.0mg Absolute Alcohol to 1.0mL The pH of this solution was determined as 6.1.
  • Example 2 Sample 2 per mL Taxol 6.0mg Cremophor EI 0.5mL Absolute Alcohol to 1 mL The solutions were filled into clear type 1 glass 5mL vials and sealed with rubber bungs. The solutions were stored at 40°C for 7 (seven) days and the stability results are shown in Table 1. Sample 1 Sample 2 pH 6.2 9.0 Potency 96.6 86.7 Major individual 0.3% 5.1% impurity Total impurities 2.0% 12.2%
  • the solution was filled into clear type I glass 5mL vials and sealed with rubber bungs.
  • the solution was stored at 40°C for 7 days.

Abstract

A composition of taxol and polyethoxylated castor oil is pH balanced to have a pH less than 8.1 to improve stability. This composition can include an acid, preferably citric acid, to adjust the pH value. The invention includes a method of formulating a taxol solution for injection by mixing an acid with a carrier material, such as castor oil, to form a carrier solution after which taxol is mixed with the carrier solution to form the taxol solution at a pH of less than 8.1. The method may include the step of slurrying the taxol in alcohol before mixing with the carrier solution.

Description

    INJECTABLE COMPOSITION
  • This invention relates to a solution of taxol (paclitaxel) having improved stability.
  • BACKGROUND OF THE INVENTION
  • Taxol is a compound extracted from the bark of a western yew, Taxus brevifolia and known for its antineoplastic activity. It is described for example in The Merck Index, Eleventh Edition 1989, monograph 9049.
  • In 1977, taxol was chosen for development as an antineoplastic agent because of its unique mechanism of action and good cytotoxic activity against IP implanted D16 melanoma and the human X-1 mammary tumor xenograft.
  • Taxol is believed to function as a mitotic spindle poison and as a potent inhibitor of cell replication in vitro. Other mitotic spindle points (colchicine and podophyllotoxin) inhibit microtubule assembly. Taxol employs a different mechanism of action since it appears to shift the equilibrium of polymerimization/depolymerization toward polymer assembly and to stabilize microtubules against depolymerization under conditions which would cause rapid disaggregation of microtubules. The interference with the polymerization/depolymerization cycle in cells appears to interfere with both the replication and migration of cells.
  • After extensive preclinical screening in mouse tumour models, taxol entered clinical trials in 1983. Over the past few years, taxol has demonstrated good response rates in treating both ovarian and breast cancer patients who were not benefiting from vinca alkaloid or cisplatin therapy. It has also shown encouraging results in patients with other types of cancer including lung, melanoma, lymphoma, head and neck.
  • For further information, reference may be made to the US National Cancer Institute's Clinical Brochure for Taxol, revised July 1991, and papers presented at the Second National Cancer Institute Workshop on Taxol and Taxus held in Alexandria, Virginia USA on September 23-24, 1992.
  • BRIEF DESCRIPTION OF THE INVENTION
  • It is a disadvantage of the known formulation that the taxol therein degrades, with the result that the shelf life of the formulation is unsatisfactory, and there is therefore a need for a taxol solution of improved stability.
  • Accordingly, in a general aspect the invention provides a solution containing taxol, cremophor EL™ and ethanol, characterized in that the pH of the solution has been adjusted into the range 1 to 8 by addition of an acid. Acids in the form of powders, for example citric acid, are preferred over those which contain water, for example sulfuric acid. The most preferred acid for use in accordance with the present invention is citric acid but a wide range of acids may be used including the following:
  • Citric acid - monohydrous
  • Citric acid - anhydrous
  • Citric acid - hydrous
  • Acetic acid
  • Formic acid
  • Ascorbic acid
  • Aspartic acid
  • Benzene sulphonic acid
  • Benzoic acid
  • Hydrochloric acid
  • Sulphuric acid
  • Phosphoric acid
  • Nitric acid
  • Tartaric acid
  • Diatrizoic acid
  • Glutamic acid
  • Lactic acid
  • Maleic acid
  • Succinic acid
  • DETAILED DESCRIPTION OF THE INVENTION
  • Due to its limited solubility in water, Taxol is usually prepared and administered in a vehicle containing cremophor EL™ (a polyethoxylated castor oil which acts as a solubilizer) and ethanol. A commercially available solution supplied by Bristol-Myers Squibb (BMS) is formulated with these components and has a pH of 9.1.
  • As indicated above, the invention essentially teaches addition of an acid to a taxol formulation to adjust its pH into the range 1 to 8, preferable 5 to 7.
  • In a preferred procedure adopted by the applicant, which it will be clearly understood is non-limiting, the following steps were carried out:
  • Mixing Instructions SOLUTION 1
  • Citric acid was dissolved in absolute alcohol, using a ratio of 8mls of absolute alcohol to 1 gram of citric acid, and the solution was stirred for fifteen (15) minutes.
  • SOLUTION 2
  • Cremophor EL was weighed out into the main mixing vessel.
  • SOLUTION 3
  • Solution 1 was added to solution 2, and the container used for solution 2 was washed with a minimum quantity of absolute alcohol to ensure complete transfer of the citric acid. Solution 3 was mixed and bubbled with nitrogen for at least 15 minutes. The taxol was weighed out and slurried using absolute alcohol, using a ratio of 8ml of absolute alcohol to 1 gm of taxol. The slurried taxol was added to solution 3 and the slurrying vessel was washed with a minimum quantity of absolute alcohol. Solution 3 was adjusted to 75% of required volume using absolute alcohol, and thoroughly stirred for at least 45 minutes until completely dissolved. Once completely dissolved, the volume, was checked and made up as necessary with absolute alcohol and the final solution stirred for 5 minutes.
  • Example 1
  • A solution was prepared with the following formulation:
    Formulation: (Sample 1)
    Cremophor EL 0.5mL
    Citric Acid (Anhydrous) 2.0mg
    Taxol 6.0mg
    Absolute Alcohol to 1.0mL
    The pH of this solution was determined as 6.1.
  • The stability of this sample was compared with a sample prepared by the formulation stated in the NCl Taxol Clinical brochure (as follows) which had a pH of 9.1. (Sample 2)
    Sample 2 per mL
    Taxol 6.0mg
    Cremophor EI 0.5mL
    Absolute Alcohol to 1 mL
    The solutions were filled into clear type 1 glass 5mL vials and sealed with rubber bungs.
    The solutions were stored at 40°C for 7 (seven) days and the stability results are shown in Table 1.
    Sample 1 Sample 2
    pH 6.2 9.0
    Potency 96.6 86.7
    Major individual 0.3% 5.1% impurity
    Total impurities 2.0% 12.2%
  • Clearly Sample 1 showed significantly increased stability over Sample 2.
  • Example 2
  • A solution was prepared with the following formulation:
    Formulation: (Sample 3)
    Cremophor EL 0.5mL
    Taxol 6.0mg
    Absolute Ethanol to 1mL
  • pH adjusted to 6.6 with 1.0M Acetic Acid.
  • The solution was filled into clear type I glass 5mL vials and sealed with rubber bungs.
  • The solution was stored at 40°C for 7 days.
  • The stability results obtained are compared to those seen with Sample 2.
    Sample 3 Sample 2
    pH 6.7 9.0
    Potency 97.5 86.7
    Major individual 0.3% 5.1% impurity
    Total impurities 2.3% 12.2%
  • Again the significantly superior stability of the formulation according to the invention (Sample 3) is evident.
  • It will be clearly understood that the invention in its general aspects is not limited to the specific details referred to hereinabove.

Claims (33)

  1. A stabiliser formulation for use in combination with, and as a vehicle for, paclitaxel to form a pharmaceutical for use in treating cancer said formulation comprising polyethoxylated castor oil and an acidifying agent.
  2. A formulation as claimed in claim 1 wherein the acidifying agent is formic acid, ascorbic acid, aspartic acid, benzene sulphonic acid, benzoic acid, hydrochloric acid, sulphuric acid, phosphoric acid, nitric acid, tartaric acid, diatrizoic acid, glutamic acid, lactic acid, maleic acid, succinic acid, acetic acid, citric acid or anhydrous citric acid, including such agents in particulate solid form.
  3. A formulation as claimed in claim 1 or claim 2 and including ethanol as a constituent thereof.
  4. A formulation as claimed in claim 1 and comprising:-
    (i) polyethoxylated castor oil as a solubilizer for paclitaxel,
    (ii) citric acid as an acidifying agent, and
    (iii) optionally ethanol
  5. A composition comprising:-
    paclitaxel;
    castor oil; and
    anhydrous citric acid in sufficient amounts to adjust the pH of the composition to less than 8.1.
  6. A pharmaceutical composition suitable for use in treating cancer and comprising paclitaxel, polyethoxylated castor oil and an acidifying agent, the components of the composition being mixed in such proportion that said composition has a resulting pH less than 8.1.
  7. A pharmaceutical composition as claimed in claim 6 wherein the proportion of the acidifying agent is such that the pH of the composition is from 5 to 7.
  8. A pharmaceutical composition as claimed in claim 6 or claim 7 and including ethanol or other alcohol as a constituent thereof.
  9. A pharmaceutical composition as claimed in any one of claims 6 to 8 wherein the acidifying agent is formic acid, ascorbic acid, aspartic acid, benzene sulphonic acid, benzoic acid, hydrochloric acid, sulphuric acid, phosphoric acid, nitric acid, tartaric acid, diatrizoic acid, glutamic acid, lactic acid, maleic acid or succinic acid.
  10. A pharmaceutical composition as claimed in any one of claims 6 to 8 wherein the acidifying agent is acetic acid or citric acid.
  11. A pharmaceutical composition as claimed in claim 10 wherein the acidifying agent is anhydrous citric acid.
  12. A pharmaceutical composition as claimed in any of claims 6 to 11 wherein the acidifying agent is an acid in particulate solid form.
  13. A pharmaceutical composition as claimed in claim 6 and comprising:-
    (i) paclitaxel;
    (ii) polyethoxylated castor oil as a solubilizer for the paclitaxel;
    (iii) citric acid as an acidifying agent present in such an amount that the composition as a whole has a pH of from 1 to 8, and
    (iv) optionally ethanol.
  14. Use of an acidifying agent as a stabilizer for paclitaxel in a pharmaceutical composition in which said paclitaxel is carried by polyethoxylated castor oil, said acidifying agent being employed in such use in such proportion that said composition has a resulting pH less than 8.1.
  15. Use as claimed in claim 13 wherein the acidifying agent is as defined in any one of claims 9 to 12.
  16. Use as claimed in claim 14 or claim 15 and including ethanol as a constituent of the pharmaceutical composition.
  17. Use as claimed in any one of claims 14 to 16 wherein the proportion of the acidifying agent is such that the pH of the acidified stabilized pharmaceutical composition is from 5 to 7.
  18. Use as claimed in claim 14 wherein the acidified stabilized pharmaceutical composition comprises:-
    (i) paclitaxel;
    (ii) polyethoxylated castor oil as a solubilizer for paclitaxel;
    (iii) citric acid as the acidifying agent, said acidifying agent being present in such an amount that the acidified stabilized pharmaceutical composition as a whole has a pH of from 1 to 8, and
    (iv) optionally ethanol.
  19. Use of an acidifying agent for the manufacture of a medicament which comprises paclitaxel and polyethoxylated castor oil as well as said acidifying agent, which medicament has a pH less than 8.1 and which is for the treatment of cancer.
  20. Use of castor oil for the manufacture of a medicament for use in the treatment of cancer, said medicament being in the form of a composition comprising citric acid, paclitaxel and polyethoxylated castor oil and having a pH of less than 8.1.
  21. A method of formulating a taxol solution for injection, the method comprising:-
    (i) mixing an acid material with a carrier material to form a carrier solution; and
    (ii) mixing paclitaxel with the carrier solution to form a paclitaxel solution having a pH of less than 8.1 whereby the paclitaxel in the paclitaxel solution does not readily degrade.
  22. A method as claimed in claim 21 wherein said paclitaxel solution has a pH of from 5 to 7.
  23. A method as claimed in claim 21 or claim 22 wherein said acid material is an acidifying agent as defined in any one of claims 9 to 12.
  24. A method as claimed in any one of claims 21 to 23 wherein said carrier material comprises polyethoxylated castor oil.
  25. A method as claimed in claim 24 wherein said carrier material includes ethanol as a constituent thereof.
  26. A method as claimed in any one of claims 21 to 25 and including the step of slurrying said paclitaxel in ethanol before mixing said paclitaxel with the carrier solution.
  27. A composition comprising taxol in a polyethoxylated castor oil wherein said composition has a pH less than 8.1.
  28. A method of formulating a taxol solution for injection in which the taxol does not readily degrade, comprising the following steps:
    mixing acid with a carrier material to form a first carrier solution; and
    mixing taxol with the first carrier solution to form a taxol solution having a pH of less than 8.1 whereby the taxol in the taxol solution does not readily degrade.
  29. A method according to claim 28 wherein said acid is acetic acid.
  30. A method according to claim 28 wherein said acid is a citric acid.
  31. A method according to claim 28 wherein said carrier material is polyethoxylated castor oil.
  32. A method according to claim 28 including the step of slurrying said taxol in alcohol before mixing said taxol with the first carrier solution.
  33. A composite comprising:
    taxol;
    castor oil; and
    anhydrous citric acid in sufficient amounts to adjust the pH of the composition to less than 8.1.
EP04020044A 1992-11-27 1993-11-18 Injectable composition containing taxol Withdrawn EP1500393A1 (en)

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
AUPL607492 1992-11-27
AUPL607492 1992-11-27
US99550192A 1992-12-22 1992-12-22
US995501 1992-12-22
EP94901593A EP0674510B1 (en) 1992-11-27 1993-11-18 Injectable composition comprising paclitaxel
EP97121710A EP0835657B1 (en) 1992-11-27 1993-11-18 Stable injectable paclitaxel composition

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
EP97121710A Division EP0835657B1 (en) 1992-11-27 1993-11-18 Stable injectable paclitaxel composition

Publications (1)

Publication Number Publication Date
EP1500393A1 true EP1500393A1 (en) 2005-01-26

Family

ID=25644377

Family Applications (4)

Application Number Title Priority Date Filing Date
EP94901593A Revoked EP0674510B1 (en) 1992-11-27 1993-11-18 Injectable composition comprising paclitaxel
EP03025151A Pending EP1384474A1 (en) 1992-11-27 1993-11-18 Injectable composition containing taxol
EP04020044A Withdrawn EP1500393A1 (en) 1992-11-27 1993-11-18 Injectable composition containing taxol
EP97121710A Revoked EP0835657B1 (en) 1992-11-27 1993-11-18 Stable injectable paclitaxel composition

Family Applications Before (2)

Application Number Title Priority Date Filing Date
EP94901593A Revoked EP0674510B1 (en) 1992-11-27 1993-11-18 Injectable composition comprising paclitaxel
EP03025151A Pending EP1384474A1 (en) 1992-11-27 1993-11-18 Injectable composition containing taxol

Family Applications After (1)

Application Number Title Priority Date Filing Date
EP97121710A Revoked EP0835657B1 (en) 1992-11-27 1993-11-18 Stable injectable paclitaxel composition

Country Status (12)

Country Link
US (7) US5733888A (en)
EP (4) EP0674510B1 (en)
JP (1) JP2880292B2 (en)
AT (2) ATE169216T1 (en)
AU (1) AU5612694A (en)
CA (2) CA2308082A1 (en)
DE (2) DE69320206T2 (en)
DK (2) DK0674510T3 (en)
ES (2) ES2119996T3 (en)
GR (1) GR3027724T3 (en)
PT (1) PT835657E (en)
WO (2) WO1994012031A1 (en)

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